Prosthetically CAD-CAM-Guided Bone Augmentation of Atrophic Jaws Using Customized Titanium Mesh: Preliminary Results of an Open Prospective Study
Prosthetically CAD-CAM-Guided Bone Augmentation of Atrophic Jaws Using Customized Titanium Mesh: Preliminary Results of an Open Prospective Study
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DOI：
10.1563/aaid-joi-d-17-00125
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发表时间：
2018-04-01
影响因子：
1.6
通讯作者：
Corinaldesi, Giuseppe
中科院分区：
文献类型：
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作者：
Ciocca, Leonardo;Lizio, Giuseppe;Corinaldesi, Giuseppe
本研究评估了计算机辅助设计-计算机辅助加工(CAD-CAM)-定制钛网用于假体引导骨增强的结果，涉及到咬合驱动的种植体位置，下颌骨的垂直骨体积增加以及网状物暴露等并发症。9例萎缩部位骨增强患者在种植手术前采用定制钛网和颗粒骨移植物，以自体骨和无机牛骨为1:1的比例进行移植。根据种植体的位置、宽度和长度对需要增加的骨体积进行虚拟投影，并对所需的固定螺钉进行网格设计。6 ~ 8个月后，在锥形束计算机断层扫描上，下颌弓骨增加1.72 ~ 4.1 mm（平均3.83 mm），上颌骨骨增加2.14 ~ 6.88 mm（平均3.95 mm）。补片过早暴露（4 ~ 6周内）3例，延迟暴露（4 ~ 6周后）3例。一个钛网在计划时间之前被移除，但在所有增强的部位都可以插入植入物。随访期间无并发症发生。使用CAD-CAM技术进行假体引导的骨增强术显示了重要的术后补片暴露率（66%）。由于这种高流行率的网片暴露和潜在的感染可能会影响预期的骨增强，本研究建议在设计钛网时谨慎使用该方法，以避免皮瓣张力可能导致粘膜破裂。
This study evaluated the outcomes of computer-aided design-computer-aided machining (CAD-CAM)-customized titanium mesh used for prosthetically guided bone augmentation related to the occlusion-driven implant position, to the vertical bone volume gain of the mandible and maxilla, and to complications, such as mesh exposure. Nine patients scheduled for bone augmentation of atrophic sites were treated with custom titanium mesh and particulate bone grafts with autologous bone and anorganic bovine bone in a 1:1 ratio prior to implant surgery. The bone volume needed to augment was virtually projected based on implant position, width, and length, and the mesh design was programmed for the necessary retaining screws. After 6 to 8 months, bone augmentations of 1.72 to 4.1 mm (mean: 3.83 mm) for the mandibular arch and 2.14 to 6.88 mm (mean: 3.95 mm) for the maxilla were registered on cone-beam computerized tomography. Mesh premature (within 4 to 6 weeks) exposure was observed in 3 cases and delayed (after 4 to 6 weeks) in 3 other cases. One titanium mesh was removed before the programmed time but in all augmented sites was possible implant insertion. No complication occurred during prosthetic follow-up. Using CAD-CAM technology for prosthetically guided bone augmentation showed important postoperative morbidity of mesh exposure (66%). Because of this high prevalence of mesh exposure and the potential infection that could affect the expected bone augmentation, this study suggests a cautious approach to this procedure when designing the titanium mesh, to avoid flap tension that may cause mucosal rupture.